Lecture Clinical procedures for medical assisting (4/e): Chapter 18 – Booth, Whicker, Wyman

Chapter 18 - Nutrition and special diets. After you have mastered the material in this chapter, you will be able to: Describe how the body uses food, explain the role of calories in the diet, identify nutrients and their role in health, recall the Dietary Guidelines for Americans, describe the test used to assess body fat,...

Nutrition and

Special Diets

Learning Outcomes

18.1 Describe how the body uses food.

18.2 Explain the role of calories in the diet.

18.3 Identify nutrients and their role in health.

18.4 Recall the Dietary Guidelines for Americans.

Learning Outcomes (cont.)

18.5 Explain how the Food Guide Pyramid can be

used to plan a nutritious, well-balanced diet and healthy lifestyle.

18.6 Describe the test used to assess body fat.

18.7 Explain reasons why a diet may be modified.

18.8 Identify types of patients who require special

diets and the modifications required for each.

Learning Outcomes (cont.)

18.9 Describe the warning signs, symptoms, and

treatment for eating disorders.

18.10Educate patients about nutritional

requirements.

18.11Document patient education about nutrition.

• Nutrition

– How the body

takes in and utilizes food and nutrients

relationship between nutrition and health

Daily Energy Requirements

• The body requires

nutrients

– To provide energy

– To build, repair, and

maintain body tissues– To regulate body

processes

• The sum of all cellular processes that build,

maintain and supply energy to living tissue

• Phases

– Anabolism – nutrients are changed into more

complex substances that are used to build body tissues

– Catabolism – complex substances are broken down

into simpler substances and converted to energy

• Metabolism affected by age, weight, activity,

state of health, and other factors

• Kilocalorie ( calorie )

– Measurement of energy produced by food

– Amount of energy needed to raise the

temperature of 1 kg of water by 1°C.

– Used to measure the energy expended during

activities and metabolic processes – Excess calories stored as fat

– Count calories of food eaten and estimate

expenditure for activities

Apply Your Knowledge

ANSWER: Food is the source of nutrients the body needs to

function properly Sometimes a special diet is needed to

stay healthy or regain health, and some conditions require

special diets.

catabolism?

ANSWER: Anabolism converts nutrients into complex

substances needed to build body tissues Catabolism

converts complex substances into simpler forms and

converts them into energy.

– Proteins– Carbohydrates– Fiber

– Lipids– Vitamins– Minerals– Water

• Functions

– Building and repairing

cells and tissues– Maintaining water

balance– Antibody production

and disease resistance– Maintaining body heat

– Lower resistance to infection

– Interference with normal growth processes

– Can be combined to provide all 9 essential amino acids

• Functions

– Provide 2/3 of daily

energy needs– Provide heat

– Metabolize fats

– Preserve protein for

uses other than energy production

• Excess contributes to fat stores

Carbohydrates (cont.)

• Complex

carbohydrates

– Polysaccharides – long chains of sugar units– Types

• Starch – major source of energy

• Fiber

• Simple sugars

– Fruits and some

vegetables– Milk

– Table sugar

• Excess

– Stored in liver and muscles

cells as glycogen– Converted into and stored as

fat

• Does not supply

energy or heat

• Functions

– Increases and softens

the bulk of stool– Absorbs wastes and

toxins– Decreases the rate of

carbohydrate breakdown and absorption

movements

– Transport fat-soluble vitamins

– Store energy as body fat – insulate and

protect organs– Provide a feeling of fullness

Lipids (cont.)

• Saturated fats

– Primarily from

animal sources– Solid at room

temperature

• Trans fats

– Formed during

hydrogenation of vegetable oils

– FDA recommends

zero consumption

• Unsaturated fats

– Liquid at room temperature– Types

• Polyunsaturated

• Monounsaturated

Lipids (cont.)

• Lipid levels

– High cholesterol

• Heart disease/stroke

• Peripheral vascular disease

– Lipoproteins

• Carry lipids through the bloodstream

sources– Essential to health

• Part of cell membranes

• Structural basis for steroid hormones and vitamin D

• Component of bile

• Organic substances

– Essential for normal growth

and maintenance – Essential for resistance to

infection – Help the body use other

nutrients – Assist with body processes

• Well-balanced diet usually minimizes likelihood of vitamin deficiency

and nutrients– Aids in digestion

– Transports nutrients and secretions

– Flushes out wastes– Regulates body temperature

• Antioxidants – chemical agents that neutralize

free radicals (by-products

of normal metabolism)

Apply Your Knowledge

Matching:

J O B

!

Dietary Guidelines

• Established to help people

– Get proper nutrition

– Reduce occurrence of disease

Services Dietary Guidelines

• Recommendations

– Adequate nutritional

intake– Healthy body weight

– Regular physical

exercise– Increase fruits, low-fat

dairy, and grains

USDA Food Guide Pyramid

• Revised in 2005

– Emphasizes fruits,

vegetables, whole grains, beans, and nuts

– Less emphasis on

carbohydrates– Helps balance

nutritional needs with physical activity needs

• Color coded

– Orange – grains– Green – vegetables – Red – fruits

– Yellow – oils– Blue – milk products– Purple – meats/beans

• Action figure – physical activity

Food  Pyramid

Grains Fruits

Oils

Milk  Products

American Cancer Society Dietary Guidelines

• Eat more high-fiber foods

• Five or more servings of fruits and vegetables

daily

• Limit consumption of processed and red meats

• Adopt a physically active lifestyle

• Achieve and maintain a healthy weight

• Limit consumption of alcoholic beverages

Apply Your Knowledge

Match food group to appropriate color:

Yellow 

Red  

Green

ANSWER:

Assessing Nutritional Levels

Assessing Nutritional Levels (cont.)

• Measure fat as % of weight

– Skinfold test

• Measurement of the thickness of a fold of skin with

a caliper

• Total % of fat

– Optimal % differs between men and women

– Aging changes ratio – fat replaces muscle

tissue

Modified Diets

• Modifications

– Restriction of certain foods

– Emphasis on particular foods

– Change in daily caloric intake

– Change in the amount of a specific nutrient

– Change in the texture of foods

– Alteration in the number of daily meals

– Change in variables such as bulk or spiciness

Specific Modified Diets

• For treatment or prevention of

– Frequency and timing

• Three smaller meals

• Timing in relation to a procedure

– Exclusions – for food intolerances

Specific Modified Diets (cont.)

• Supplements and

parenteral nutrition

– Oral – specially

formulated to provide adequate nutrients

of a drug

Patients with Specific Nutritional Needs

• Food allergies

– Wheat, milk, eggs, and

chocolate – Eliminate from diet

• Anemia

– Iron supplements

– Dietary iron

• Cancer

– Increase caloric intake

– Adequate protein intake

– Medications – Social factors – Economic factors

• Lactose sensitivity

– Lactase not present to

break down lactose

• Children

– 1st year

• Breast milk or commercial formula

• Cow’s milk inadequate

– Nutritional needs change

• Growth spurts

• Maturation

• Increasing activity

– Hunger regulates intake

Apply Your Knowledge

1 What factors does the physician consider when

assessing a patient’s nutritional status?

ANSWER: The physician considers a patient’s age, health

status, height and weight, body frame and circumference,

percent of body fat, eating and exercise patterns, and

energy needs Culture, beliefs, lifestyle, and educational

level should also be considered during the assessment.

Apply Your Knowledge

2 Matching

_ Eliminate foods from diet A Change in texture

_ Food exchange system B Children

_ Decreased metabolism C Food allergies

_ Hunger drives eating D Parenteral nutrition

_ Modification to a soft diet E Diabetes

_ Reduced sodium diet F Elderly

_ Bypasses GI tract G Drug therapy

_ May alter food intake and absorption H Change in nutrient level

• Education of nutrition concepts

– Chronic condition – can be fatal

Eating Disorders (cont.)

– Bulimia

• Binge and purge by vomiting, diuretics, laxatives

• Usually easier to treat than anorexia

• Treatment

– Medication – Psychotherapy

• Goals

– Establish a healthy weight – Establish good eating patterns – Resolve psychosocial triggers

Eating Disorders (cont.)

• Getting help – be alert to patient report of

– Skipping at least two meals per day

– Uncontrolled eating of large amounts of food

– Using laxatives or other purges to control

weight – Avoiding social situations that interfere with

diet or exercise – Feeling disgust, depression, and guilt after

binge – Feeling that food controls life

Apply Your Knowledge

A young female patient arrives at the clinic showing a 15

pound weight loss in the last two months Her weight is

10 pounds under the average weight for her height She

states she “feels great.” What should you do?

ANSWER: Document the weight loss and report it to the

physician She may be suffering from anorexia nervosa

or bulimia, two types of eating disorders that require

medical care and psychotherapy.

consumers by reading food package labels

– Patient’s psychological condition

Patient Education (cont.)

• Guidelines

– Teach patient as an individual

– Teach a small amount at a time

– Keep explanations at patient’s level of

understanding – Reinforce good eating behavior

– Let patient be an active learner

– Provide a written diet plan

– Suggest support groups

Patient Education (cont.)

• Cultural considerations

– Influence

• Food purchases

• Like and dislikes

• Meal timing and frequency

• Attitude toward supplements

• Snacking

– Adjust diet and recipes accordingly

Apply Your Knowledge

What do you need to consider when teaching

patients about nutrition?

ANSWER: You need to consider patient likes and

dislikes, age and family circumstances, diseases and

disorders, and the patient’s psychological condition In

addition, you need to incorporate cultural considerations

into nutritional education.

Excellent!

In Summary

18.1The body uses food for three major purposes: to

provide energy; to build, repair, and maintain body tissues; and to regulate body processes

18.2Calories provide energy for the body Calories are

measured in the foods we eat We can also estimate the amount of calories used by the body during

activity

18.3The body needs a variety of nutrients for energy,

growth, repair, and basic processes There are several food components that provide nutrients These are

proteins, carbohydrates, fiber, lipids, vitamins, minerals, and water

In Summary (cont.)

18.4 Dietary guidelines suggest the types and quantities of

food that people should eat each day They may also contain recommendations about which types of foods

to limit and which types of foods to increase

18.5 The Food Guide Pyramid provides recommendations

for eating a variety of nutrients and maintaining physical activity Following the Food Guide Pyramid recommendations promotes a well-balanced diet and healthy lifestyle

18.6 Calipers are used to perform a skinfold test that

determines the percentage of body fat

In Summary (cont.)

18.7 Dietary modifications may be used alone or in

combination with other therapies to prevent or treat illness

18.8 Patients with allergies, anemia, cancer, diabetes,

advancing age, heart disease, hypertension, lactose sensitivity, and obesity need special diets In addition, pediatric, pregnant, lactating, and debilitated patients,

as well as those undergoing drug therapy, need modifications to their diet

In Summary (cont.)

18.9 You should now the signs and symptoms of eating

disorders in order to evaluate for these disorders during the patient interview Some of the more common signs and symptoms for each include:

– anorexia nervosa – unexplained weight loss,

self-starvation, and fear of weight gain

– bulimia – eating large quantities of food in a short

period of time, going to the bathroom immediately after eating, and using laxatives to excess

– binge eating – not followed by purging and weight

gain

In Summary (cont.)

18.10 You may play a major role in educating patients

about special diets and in helping them to implement dietary changes as instructed by physicians and

dietitians Knowledge of basic nutritional principles and current nutritional findings will help you perform these tasks with confidence and competence

18.11 Documenting nutritional education is part of

preventative health care practice and is required to help ensure payment by managed care and other health insurance companies

End of Chapter 18

He that eats  till he is sick  must fast till 

he is well. 

 ~English Proverb